Leadership Skills

Effective Leadership Skills

1. Establish a clear leader
2. Collaborate and share information

Scenario

RRT to RM S408.

Sign-out: 81M, SVT now stable.

Scenario

• Suddenly, HR 160 and MAP drops 85 to 65

Scenario

What’s your schema for this situation?

What key data informs your treatment?

How do you convey your thinking to the room?

Scenario

You share your assessment and plan to administer IV metoprolol with the team, then…

• 3 individuals (DOCTOR badges) you don’t know enter the room and don’t introduce themselves.

• You discuss the situation with the family outside the room - many questions.

• RN asks clarification: what metoprolol dose?

Scenario

• While talking with family, RN calls out the patient’s not responding. A new EKG shows

Scenario (postscript)

• Individuals are primary CV team, who are unaware it’s a rapid.

• Turns out the primary team had also told the RN to give Metop - multiple doses.

• Patient requires trans-cutaneous pacing - who’s making that decision?

What went wrong?

Establish a clear leader:

Are you running this RRT or not?

“I’m ____, the resident on the code team. Is anyone running this rapid?”

“Ok, I’m running this rapid”, or “Can I take Over”, or “OK, how can I help?”

Establish a clear leader:

Be the point person

Collaborate and Share Information

Invite suggestions with a constructive tone

Try:

• Think out loud: “That qrs is wide, but the rhythm looks irregular”

• Summarize: “MAP is OK, I think this is AFib, so…”

• Encourage: “Good thought, yes…”

Why?

• The team has a lot of context-specific experience

• Actual team dynamics: residents and (for example) experienced ICU RN’s; primary team

Scenario Revisited

What would you do differently?

Scenario Revisited

What would you do differently?

• Primary team identified; confirmed they want you to run response

• Standing at the head of the bed, delegating all other tasks.

• You verbalize your rhythm interpretation schema.

• Ideas from the entire team